2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
golden standard in bariatric surgery, the gastric bypass.
Endoscopic evaluation and surveillance on the follow-up of
AGB band is an important tool witch its interface will be
described. AIM: Evaluate upper endoscopies and endoscopic
procedures in a series patients submitted to laparoscopic AGB
in a 4 year period. CASUISTIC: Between December of 1999 and
July of 2004, 1111 patients were submitted to AGB under NIH
indications for bariatric surgery. Among those AGB patients,
356 were submitted to upper endoscopies and procedures by
endoscopists of reefer centers with proper training in dealing
with endoscopy in AGB. 217 were female (61%) with a followup
between 45d e 4y (M=20months) and had their data retrospectively
analyzed. METHODS: The endoscopic evaluation of
the AGB consists in analyze the esophagus looking for dilatations
and esophagitis. In the gastric pouch, the endoscopists
had to look for its extension, mucosal damage, contents, centralization
and shape. The stoma was evaluated in terms of its
axis and if it is easy to pass trough. In the stomach the band
fundoplication was analyzed by its shape and integrity. The
rest of the stomach and duodenum were analyzed on routine
manner. RESULTS: From 356 (32% of 1111 AGB) patients submitted
to endoscopies in this AGB series, 259 (72,7%) were
considered as normal (compatible with the endoscopic expectations
of AGB), with a gastric pouch in between 5cm (M =
2cm), stoma centered and easy to pass and a compatible fundoplication
on u-turn maneuver. 53 (14,8% of endoscopies)
presents with any grade of erosive esophagitis . Esophageal
dilatation - acalasia like occurred in 2 (0,56%), Food impactation
in 1(0,28%). The main complications found on the AGB
endoscopies were; slippage in 31 (8,7% ) and band migration
in 10 (2,8%) patients .The patients with esophageal dilatation
had their band deflated, the food impactation was removed,
patients with slippage had their band repositioned by
laparoscopy and 5 of the migrated bands were removed by
endoscopy. CONCLUSION: By the numbers presented above it
is clear that the interface between AGB and endoscopy plays
an important rule on the follow-up of AGB patients and suold
be stimulated
P296–Flexible Diagnostic &
Therapeutic Endoscopy
1000 COLONOSCOPIES IN OCTOGENARIEANS, JP Gonzalvo
DO, J E Efron MD,A M Vernava MD,D M Jones MD,M E Avalos
MD,M A Liberman MD, Cleveland Clinic Florida-Naples
Objectives: To evaluate the endoscopic and pathologic findings
in colonoscopy performed in 1000 patients greater than 80
years of age at a single institution.
Methods: We retrospectively queried the endoscopic database
for patients greater than 80 years of age that under went
colonoscopy at the Cleveland Clinic Florida-Naples from May
24, 1999 to September 15, 2004. We analyzed the indications,
findings, complications, and pathology of those patients.
Results: Indications for colonoscopy included screening (174),
follow up of polyp (171), bright red bleeding (133), anemia
(114), abdominal pain (73), diarrhea (57), follow-up cancer (54),
surveillance (52), constipation (51), change in bowel habit (46),
hemocult positive stools (41), family history of colon cancer
(39), melenic bleeding (23), hematochezia (21), weight loss
(21), and other diagnoses. Our endoscopic findings were
polyps in 545 patients, diverticular disease in 716, mass in 26,
AV malformations in 21, inadequate bowel prep or incomplete
colonoscopy in 8, ulcer in 6, stricture in 6, and a normal colon
was found in 94 patients. The pathology of biopsied lesions
showed a total of 19 adenocarcinomas, 8 high-grade dysplastic
lesions or carcinoma in-situ, 37 tubulovillous adenomas, 303
pts. with tubular adenoma, and 275 pts. with hyperplastic
polyp. The total number of complications in this patient group
was 5, this included 1 perforation, and 1 bleeding episode after
polypectomy.
Conclusion: Colonoscopy can be safely performed in octogenarians.
The bowel preparation is well tolerated and the procedure
can be performed to completion in >99% of the patients.
A majority of octogenarians will require therapeutic colonoscopies
and therefore it is the procedure of choice in examining
the colon.
204 http://www.sages.org/
P297–Flexible Diagnostic &
Therapeutic Endoscopy
PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN THE COM-
PLICATED OBESE PATIENT CAN BE PERFORMED SAFELY,
James L Guzzo MD, Grant V Bochicchio MD,James Haan
MD,Steven B Johnson MD,Adrian Park MD,Thomas Scalea
MD, University of Maryland Medical Center and the R. Adams
Cowley Shock Trauma Center
Introduction: Percutaneous endoscopic gastrostomy (PEG) has
become a commonly performed procedure with an acceptable
complication rate. There is an absence of data reporting the
success and complication rates of PEG placement in the obese
and morbidly obese (MO) patient.
Methods: Prospective data was collected from January 2001 to
June 2004 evaluating the safety of our experience with PEG in
obese and MO patients. In addition to BMI, patients were stratified
by no previous abdominal surgery (NPAS) and previous
abdominal surgery (PAS). Complication rates were evaluated
by number of successful attempts, wound complications,
bleeding, and tube dislodgement.
Results: 103 patients underwent attempted PEG placement
over the 3 _ year study period. Mean age of the study group
was 55 ± 13 years, 73% were male, and 80% were trauma
patients. The most common indication for PEG was dysphagia
2° to chronic respiratory failure following traumatic brain
injury. The overall success rate of PEG was 94% with a complication
rate of 9.7%. There was no significant difference in the
complication rates between NPAS and PAS patients.
BMI (kg/m2) 30-40 41-70 >70
Successful PEG 83/89 17/17 3/3
Wound 5/83 2/14 0
Bleeding 1/83 0 0
Dislodgement 2/83 0 0
Conclusions: PEG can be safely performed in this challenging
patient population. Lessons learned from treating obese and
morbidly obese patients will help push the already expanding
frontiers of endoscopic and laparoscopic surgery.
P298–Flexible Diagnostic &
Therapeutic Endoscopy
IS THERE ALWAYS AN HIPERTONIC LOWER ESOPHAGEAL
SPHINCTER IN ACHALASIA, Edgardo Suarez MD, Jose J
Herrera MD, Jesus A Insunza MD,Maria E Lopez
MD,Hiosadhara E Fernandez MD,Jose A Palacios MD, Hospital
Español de México GI motility and endoscopy unit. Hospital
General ?Dr. Manuel Gea González?, GI motility unit and general
surgery division.
Achalasia is an esophageal motor disorder characterized for
the absence of primary progressive peristalsis in the esophagus;
abnormalities in the lower esophageal sphincter (LES)
have been described. This disease was first described by Sir
Thomas Willis in 1674. It is the best known esophageal motility
disorder. There are 0.03-1.1 cases every 100,000 persons per
year. The name derivates from Greek, meaning ?lack of relaxation?
and regards to the LES. The recent manometric studies
have suggested that these LES abnormalities are not always
present and the diagnostic criteria for achalasia have been
changed. The absence of peristalsis is the mandatory manometric
finding for achalasia diagnosis. Other manometric findings
of the esophageal body, the LES and upper esophageal
sphincter (UES) are not always present and are not required
for diagnosis.
AIM: To know LES and esophageal body manometric findings
in achalasia patients.
We reviewed clinical presentation and manometric findings of
patients with achalasia diagnosis between April, 1998 and
July, 2004. Manometric study was done with solid state
Konigsberg-Castell We used stationary and pull through technique
according to Castell protocol.
RESULTS: One hundred thirty six patients were included.
Average age was 42.5+-SD 16.5 years. There were 54.4%
female (n=74) and 45.6% male (n=62). Dysphagia was present
in 88.1% of cases, regurgitation in 62.7%, and chest pain in
50.8%, weight lost in 45.7% and heartburn in 35.5%.